Prematurity Awareness and Labor Induction

I learned from RH Reality Check that yesterday was Prematurity Awareness Day.  According to March of Dimes president Jennifer Howse, the United States has one of the highest rates of premature birth in the industrialized world, receiving a letter grade of "D" from the MoD.   The March of Dimes cites lack of access to early prenatal care and education as a main reason for the discrepancy. 

While I appreciate blogger Robin Marty for calling attention to this major problem in the United States, I must say I was shocked to find no mention of a common medical practice that contributes to premature birth: labor induction without medical indication. 

Others would call this "elective induction," but I've seen enough to know that it's usually the doctor, not the mother, that pushes for the induction, and therefore I find the term "elective" puts undue blame on the mother.  After all, we're supposed to trust our care providers.  When a doctor tells you that you "need" to be induced, we're not supposed to have to ask why.  We figure the term "need" means there's a problem.  But when it comes to induction of labor, a doctor telling you it's "needed" without providing an explanation usually means it's not needed at all.  (I always encourage my clients to ask lots of questions, even if they have a care provider that lays everything out for them.  If there's a problem, they'll usually tell you, but if they're pushing for an induction without saying why, you should know beforehand what the problem is, if any.)

Estimated due dates are just that: estimates.  In most cases, your body is the best indicator of when a baby is ready to be born, and the onset of labor is your cue.  Unless there is another complication (pre-eclampsia, placental insufficiency, gestational diabetes, etc), most babies will come when they're supposed to come.  As my dad says, "Babies are always right on time."  Inducing labor for the convenience of the doctor, the parents, or even the doula might seem okay or even preferable, but you could be cutting off valuable gestation time where the baby will be getting her/his final developmental markers.

In other words, babies born from induction can be (and sometimes are) classified as premature even if they're born at or slightly after the 38 week mark.  Again, your estimated due date is just an estimate, and different babies take different amounts of time to be "ready."  Studies show babies born at 38 weeks from a spontaneous labor have much better outcomes than babies born at 38 weeks from induction.  Babies born from induction are more likely to have jaundice, respiratory distress, lower APGAR scores, difficulty establishing a sleep cycle, increased risk for sepsis, and of course, difficulty breastfeeding.  Many induction babies need transfer to the NICU.  Being induced puts the mother at risk for cesarean, difficulty establishing a milk supply, and retained placenta (with or without cesarean surgery). 

Of course, there are good medical reasons to induce, and you should trust your care provider to help you make that call.  If there is an emergency and the baby needs to be born, good medical care and support from trained professionals can help curb these problems, but if induction is not necessary, why take the risk?  As far as the prematurity issue goes, well, you simply cannot address premature birth without addressing the medical practices that cause more babies to come too soon, and that practice is routine induction without medical indication.